Provider Demographics
NPI:1871931493
Name:MONACO, GINA (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:
Last Name:MONACO
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1723 BROADWAY ST STE 410
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-4556
Mailing Address - Country:US
Mailing Address - Phone:573-332-7746
Mailing Address - Fax:573-339-9709
Practice Address - Street 1:1723 BROADWAY ST STE 410
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-4556
Practice Address - Country:US
Practice Address - Phone:573-332-7746
Practice Address - Fax:573-339-9709
Is Sole Proprietor?:No
Enumeration Date:2013-06-05
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61005014207T00000X
IN11016988A390200000X
MO2021045105207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program